Preventive Dentistry

It is the art and science of preventing disease, prolonging life and

promoting physical and mental efficiency through organized community
effort.

Public
The modern concept of health is wellHealth
stated by the WHO: “ Health is a state
of complete physical, mental and social well-being, and not absence of
disease or disability.

ADA define dental public health as the art and science of preventing and
controlling dental diseases and promoting dental health through organized
community efforts.
 In applying public health, the method of application
should have the following characteristics:
1 It must be done in areas where group responsibility is recognized.

2 Public health method depend on team work.

3 Public health work should deal with all parts of problems.

4 Public health methods must depend on biostatistics.

Public health deals with healthy and apparently healthy as well as with diseased people.
5

6 Education of the public and adaptation of public health programs to community culture.

6 Prevention is considered a major objective of public health programs:

a) Prevention of a disease is greater good in life than its cure.
b) Prevention can be better performed on mass population through public health.
c) Prevention is cheaper than cure.
Preventive Dentistry
 Objective of preventive Dentistry:
1- Factors which predispose to disease or disorder.

2- The disease it self.

3- Factors which evoke more severe manifestations of acute disease.

4- Factors which tend to maintain disease in a chronic state.

5- Factors which permit the progressive advance of disease.

6- The concomitant effects or the complications of disease.

7- The sequalae of disease, both local and systemic.

8- Factors which maintain disability resulting from disease.
9- Factors which interfere with rehabilitation.

Tertiary Prevention
Rehabilitation
Replacement of tooth
structure by appliances
bridge, partial
LEVELS OF PREVENTION
Period of Pathogenesis
Disability limitation
Treatment of well developed
lesions
Pulp capping
Root canal thearpy
Restoration of natural teeth
Extraction
Orthodontic treatment
Secondary Level of Prevention
Early Diagnosis and prompt
treatment
Periodic detailed oral examination
with Xray
Prompet treatment of incipient
lesions
Extension for prevention.
Attention to developmental defects
Compulsory examination of school
children.
Period of Prepathogensis
Primary Level of Prevention
Specific protection Health promotion
Good oral hygiene Health education in oral
Fluoridation of public water hygiene
supplies Good standard of nutration
Topical fluoride application Diet planning
Avoidance of sticky foods, Periodic inspection
particularly between
meals
Tooth brushing after eating
Dental prophylaxis
Treatment of highly
susceptible but
uninvolved areas in
highly susceptible
persons
Preventive orthodontics
 CARIES RISK ASSESSMENT
It is the identification of individuals at high risk for any future disease as
dental caries, periodontal disease, etc.

Importance of caries risk assessment:

1- Define those in most need.
2- Improves the effectiveness of preventive measures and levels of
treatment.

Accordingly, preventive interventions should involve those individuals at

higher risk than others and emphasizes the various levels of prevention.
 Caries Susceptibility (activity) Tests:

There is a number of tests which aim to predicting future caries activity.

Advantages of Caries activity Tests:

1- Permit the identification of individuals with a higher probability of

developing dental caries.
2- Permit dental health personal to screen large segments of the population
e.g. school children.
3- Provide a patient with an objective evaluation of caries risk before dental
procedure and therefore gives the appropriate line of treatment.
 A- The Lactobacillus Count Test :
There is a correlation between the number of lactobacilli and
dental caries activity.
Its objective is to find the number of lactobacilli present in a
patients mouth.
Technique:
1. A specimen of saliva is collected by the patient chewing on a
cube of paraffin wax first thing after getting up in the morning
and spitting into a sterile bottle.
2. The saliva is diluted and spread it on tomato agar plates (pH 5)
3. Incubated for 96 hours.
4. The colonies are counted and the number of lactobacilli per ml
of the original saliva calculated.
Patients with a count:

 over 10,000 have moderate to marked caries

activity
 between 1000 and 10,000 slight to moderate
caries activity
 below 1000 very slight or none caries activity
 B- Methyl red test:

-The use of water soluble methyl red pH indicator for disclosing those areas of
tooth surface that develop hydrogen ion concentrations below pH 5.2.

-Aqueous methyl red (0.216%) is a chemical indicator that changes from

yellow at pH 6 or above to deep red at pH 5.
 C- The Synder test:
►This test measures the ability of micro-organisms to form acid from a
Carbohydrate medium.
►A sample of 0.2 ml of saliva inoculated into a glucose agar medium with indicator
bromocresol green.
►This is incubated along with a control without saliva and a change in color to
yellow indicates a fall in pH or acid formation.
►If the change occurs within 24 hours, it indicates marked caries activity in the
child.
►If it occurs within 48 hours, it indicates moderate activity.
►If the change occurs above 72 hours, this indicates no caries activity.
 The Modified Synder test (Alban's test):
►The patient is asked to spit unstimulated saliva directly into the tube until
there is a thin layer of saliva covering the surface of the green agar, the tube
is then incubated for 4 days. Color changes will be observed.

◘ A zero score indicated ---→ no color changes

◘ 1+ score is a color change to yellow in the top ¼ of the tube.
◘ 2+ score is to the half way mark.
◘ 3+ score is to ¾ mark.
◘ 4+ score is when the entire length of the agar column has changed to
yellow.

Score 4+ at the end 24 hours ---→ very susceptible

Zero at the end of 96 hours ---→ very resistant
 E- Dip slide method:
1-
2-Dip
Dip slide methodfor
slide method forS.lactobacillus count:
mutants count:
Aundiluted,
specially paraffin-
designedstimulated
dip slid of saliva
plasticisispoured
coatedonwith lactobacilli
a special selective
plastic agaris
slide that
added
coatedtowith
undiluted, paraffin- agar,
Mitis Salivarius stimulated saliva20%
containing is flowed over the agar surface →
sucrose.
placed into sterile tube, which is tightly closed and incubated at 37c˚ for 4 day.
Then incubated at 37c˚ for 48 hours.
►Reading of more than 10.000 colonies/ml of saliva → considered high
►Reading of more
►1= low when than are
the colonies 1000 colonies/ml
discrete less thanof saliva
200 → considered low
colony.
►Reading
►2= mediumbetween 1000-10.000
when the colonies colonies/ml
are more of saliva → considered
than 200 colony.
medium.
►3= high when the colonies are tiny and uncountable.
 Definition
The term caries is derived from the latten word cariosus, meaning
decay or rotten. It is the localized destruction of smooth, pit and
fissure enamel as well as dentin and cementum of the teeth.
♦ Caries is the most chronic disease affecting the human race.

♦ It affects both sexes, both primary and permanent teeth in all

ages, in all races and in all socio-economic strata and in every
area in the world.

♦ Once caries occurs, its manifestations persist throughout life

even through the lesion is treated.
 IN EGYPT

• ABOUT 30% OF 3 YEAR-OLD CHILDREN HAVE CARIOUS

TEETH, THIS PERCENTAGE INCREASES STEADILY TILL IT
REACHES 60 % AT THE AGE OF 6 YEARS AND 90% AT THE
AGE OF 9 YEARS.
 Etiology

However there are 3 main theories which explain the etiology

of dental caries:

The acidogenic, the proteolytic and the proteolysis-chelation

theory.
The most accepted theory of dental caries is Miller's
chemico-parasitic theory (acidogenic theory).

+
Infected
AcidPlaque Susceptible
Diet
Bacteria tooth surface
sucrose

Dental caries
acid
 Diet

Plaque Tooth

Time
There is a continuous process in the oral cavity:

Decalcification Remineralization

Saliva

Supplemental
food, drinks
Acids
Tooth pastes
Effects of some
food and drinks Drugs
So
TO PREVENT DENTAL CARIES:
Decalcification
Remineralization
Through:

I. Diet control.

II. Oral hygiene measures.

III. Topical protection of teeth.

IV. Systemic protection of teeth.

 I- Dietary Control of Dental Caries: (dietary measures)
How can diet affect the prevention of dental caries ?

Locally Systemically

Through the oral environment, by A. Essential nutrients carried by the blood

controlling the lodgment around the
teeth of fermentable carbohydrate
debris which clears slowly from the
mouth.
By eating food rich in :fibrous elements
decrease the oral clearance time of
carbohydrates.
stream from the digestive tract.
B. Before birth through the placental
circulation from the mother to the fetus
affect the chemical composition of the
tooth its development and maturation.
 THE ORAL CLEARANCE TIME

• IS THE TIME NEEDED FOR THE MUSCLES OF THE MOUTH AS WELL AS

THE BUFFERING ACTION OF SALIVA TO REMOVE THE FERMENTABLE
CARBOHYDRATES FROM THE TOOTH SURFACE AS WELL AS
NEUTRALIZATION OF THE FORMED ACIDS
 Carbohydrates

Route of Chemical Physical

administration composition composition

Presence of
Frequency Other food
substances
 STEPHAN CURVE
FREQUENCY
Carbohydrate should not be completely restricted but dietary
recommendations can be given to the patient to improve the oral
environment, these are:
1- Keep the carbohydrates content of the diet as low as possible consistent
with satisfactory caloric intake.

2- When carbohydrates are used select wherever possible the soluble forms or
those that clear the mouth most quickly.

3- Consume carbohydrate at meals so far as possible. A void between meal

snacks.
Diet for good general nutrition must contain:
1- Sufficient amount of minerals especially calcium and phosphorous.
2- Sufficient amount of vitamins particularly vitamins D&C.
3- Reduced amount of carbohydrates, especially freely fermentable
varieties.
4- Enriched phosphates.

A good balanced diet must contain:

1- The milk group.
2- The meat group.
3- The vegetable and fruit group.
4- The bread and cereal group.
INSTRUCTIONS FOR PROPER DIET:

1 -3 MEALS CONTAINING MORE PROTEIN, VITAMINS, FAT, MINERALS AND LESS

CARBOHYDRATES (SP. SWEETS).
2 - FRESH FRUITS AND VEGETABLES ARE IMPORTANT DURING AND AFTER
MEALS
3 - SNACKS, (SP. STICKY REFINED CARBOHYDRATES) SHOULD BE AVOIDED
REP
4 - CONSUMPTION OF SUGARS IN A LIQUID FORM (WHICH CAN BE WASHED
AWAY QUICKLY FROM AROUND THE TEETH SURFACES) RATHER THAN STICKY
FORM (WHICH REMAINS FOR A LONGER PERIOD ON THE SURFACES OF THE
TEETH).
 INSTRUCTIONS FOR PROPER DIET:

1 -3 meals containing more protein, vitamins, fat, minerals and less

carbohydrates (sp. sweets).
2 - Fresh fruits and vegetables are important during and after meals
3 - Snacks, (sp. sticky refined carbohydrates) should be avoided rep
4 - Consumption of sugars in a liquid form (which can be washed away quickly
from around the teeth surfaces) rather than sticky form (which remains for a
longer period on the surfaces of the teeth).
 INSTRUCTIONS FOR PROPER DIET:

5 - Drink water after each snack or meal…….WHY???

6 - Put pieces of fresh vegetables (e.g. cucumber or carrot) in the sandwiches
taken to the school/ give it to the child to eat it after the sandwich….WHY???
7 -Children may chew natural or sugar-free gum, it satisfies the child and at the
same time cleans the teeth by the mechanical action of chewing.
8 - Drink water after a sugar-containing syrup-form of a medicine
 But Before giving these instructions we have to make:

Diet history analysis

It is done when vague reports from patients make it impossible to determine with any
accuracy whether an adequate diet is ready being obtained.

- Parents should write down every thing the child eats or drinks all day long for 3
successive days or a week.
-These sheets will allow the dentist to: study the dietary behavior of the child
analyze the child habits
− Results are compared with the recommended diet and with the desirable
distribution of foods among the four basic food groups.
−From this analysis factors can be brought to light which may have escaped the
patient's notice.
 Diet analysis gives the dentist an idea about:

1. The total amount of carbohydrates consumed.

2. Its proportion with respect to protein and fat.

3. Whether retentive or not.

4. The time of consumption .

Accordingly, recommendations for changing the dietary habits of

this patient can help in improving the caries condition.
 II. ORAL HYGIENE MEASURES

A. Tooth Brushing

B. Disclosing agents

C. Tooth paste

D. Other cleaning devices

E. Oral rinsing

F. Dental prophylaxis
 A.Tooth Brushing :
Tooth Brush Design :
-Different shapes, texture, sizes and patterns of tooth
brushes.

-Straight brush is the preferred one.

-Efficient to all parts of the mouth.

 The desirable qualities of a toothbrush are:

1- Manmade bristles of about 0.4mm thick x 12mm long.

2- Firm and resilient bristles with rounded and polished ends.
3- Short head (about 2.5cm) with flat brushing surface (2.5x0.5cm)
to permit access to all surfaces of the teeth.
4- Multitufted, 2 or 3 rows of separate bundles of bristles.
5- Able to remove plaque from teeth..

• Electric tooth brush offers mechanical aid and less manual effort to achieve some
sort of hygiene. It is recommended in case of disabled individuals.
 0-6 Months
-When your baby is born, they don’t have teeth, so there’s no reason to use an actual toothbrush
and toothpaste for cleaning a newborn’s mouth.
-But brushing their gums is a great way to establish the habit of cleaning their mouth regularly. 
-When it comes to how to brush baby’s gums, there’s not much to it. After a feeding, take a clean,
damp washcloth or baby gum brush and gently run your index finger over your baby’s gums.
-Since newborns eat several times a day, aim to do this at least twice daily — just as they would if
they were brushing.

Once your baby cuts their first tooth, it’s time to switch to a soft-bristled brush designed
specifically for infants and young toddlers.
But don’t stop washing their gums! Even once their first tooth arrives, your baby’s gums will still
experience exposure to anything they place in their mouth.
Washing their gums as part of your regular oral hygiene routine is essential until they have more
teeth covering the area of their gums.
It will also help ease their discomfort as their teeth continue to break through their gums.
Oral Care For Baby
 When Should My Child Start Seeing a Dentist? 

As soon as teeth appear in the mouth, decay can occur.

The American Academy of Pediatric Dentistry recommends

that a child go to the dentist by age 1 or within six months
after the first tooth erupts.

Tips on caring for your child’s teeth and a free printable tooth
brushing chart to make brushing fun and part of their daily routine!
 B- Tooth brushing methods:

For the patient to continue regularly and routinely brushing effectively his
teeth, he must be educated and convinced by the importance and benefits
of cleaning his teeth. So for teaching an effective tooth brushing technique,
the dentist must emphasize the following:

1) Motivation
2) Education
3) Demonstration
4) Assessment
Tooth brushing methods:
Should be able to demonstrate at least 2 methods

a. The rotation or roll method

b. The Fone’s Method

 a- The rotation or roll
method
-The most commonly recommended
-The bristles are placed on the alveolar mucosa pointing
away from the occlusal surface
-The side of the bristles presses against the attached gingiva
and sulcus area.
-The bristles are rolled across the gingiva towards the
occlusal keeping the sides of the bristles pressed firmly
against the tissue (they should appear to blanch)
-This stroke is repeated 10 times in each region
-The occlusal surfaces are then brushed with back and
forward action
-The brush is held vertically for the lingual surfaces of the
upper and lower incisor teeth.
The rotation or roll method:
b- The
Fone's
method:
b- The
Fone's
method:
b- The
Fone's
method:
b- The
Fone's
method:
b- The
Fone's
method:
b- The
Fone's
method:
b- The Fone's method:

For young children, Fone's method of teeth brushing from the outer
surface is recommended.
- Brushing should be done immediately after eating at least twice a day.

- While brushing, teeth should be put in occlusion.

- Systematic way of brushing should be used.
- Brushing the lingual surfaces of the teeth must be done.
II. ORAL HYGIENE MEASURES

A. Tooth Brushing

B. Disclosing agents

C. Tooth paste
D. Other cleaning devices

E. Oral rinsing
F. Dental prophylaxis
 C. Disclosants:
Disclosants are water soluble dyes used to stain the plaque and other deposits and
make them obvious.

The desirable properties of a disclosing agent should be:

a) Having the ability to stain plaque selectively and not the other surface of the teeth
and their surrounding.
b) Do not stain the rest of the oral structures, lips, cheeks and tongue. c) Does not
discolor anterior teeth fillings.
d) Has an acceptable taste.
e) Has no harmful effects on the mucous membrane, if it is accidentally swallowed, it
should have no possible allergic reactions.
It is essential to make the deposits visible.
1- To confirm to the patient the presence of harmful film and hence facilitate
instruction on its removal.

2- To enable the dentist, during scaling and polishing procedures and to

confirm that the tooth surfaces are free from all deposits.
II. ORAL HYGIENE MEASURES

A. Tooth Brushing

B. Disclosing agents

C. Tooth paste

D. Other cleaning devices

E. Oral rinsing

F. Dental prophylaxis
D- Tooth paste (Dentifrices) and tooth powder:
A dentifrice is a substance used with a tooth brush to remove bacterial
plaque, materia alba, and debris from the gingiva and the teeth for cosmetic
purposes and for applying specific agents to the tooth surfaces for
preventive and/ or therapeutic purposes.
 Component of the dentifrices:

◊ Detergent 1-2%
◊ Cleaning and polishing agents 20-40%
◊ Binder (thickener) 1-2%
◊ Humectants 20-40%
◊ Flavoring 1- 1.5%
◊ water 20-40%
◊ Therapeutic agent 1-2%
◊ Preservative, sweetener and coloring agent 2-3%
◊ A therapeutic dentifrices has a drug or chemical agent added for a specific
preventive or treatment action.

Fluoride-containing tooth pastes: MFP, APF, and amino F

 C.Tooth paste (dentifrices)
-Many different varieties of tooth paste have been used.
-Therapeutic dentifrices are those which contain agents to inhibit the
growth of oral microorganisms or increase the resistance of the dental
hard tissues.
-Some contains: ammonium compounds, chlorophyll, antibiotics,
fluorides,etc.
-The best are those containing fluorides
-Dentifrices which aim to inhibit bacterial growth or action are
always faced with the disadvantage that after continuous use,
different strains of bacteria will appear by mutation that are resistant
to the therapeutic compound.
-Should be of acceptable taste and flavor
-Unobjectionable color and consistency
-Components should not possess any detrimental effect on prolonged
use.
Special guide lines specific for young children:
1- Use a pea- sized amount of toothpaste on the brush.
2- Use formulations with low fluoride concentration (500-600ppm)for
children younger than 7 years.

3- To avoid increased risk of toothpaste ingestion brushing should be

supervised by parents. Use the “cup test” to check if the child could
rinse and spit without swallowing

Special purpose of tooth pastes:

Some patients who have sensitive cervical areas on their teeth may
benefit from the use of desensitizing pastes such as: Synsodyne or
Emoform.
 FLUOROSIS

5 year olds swallow 25%

of toothpaste Children under 2 years
swallow 50% of toothpaste

1 to 3 grams

Toothpaste = 1 mg F / gram “pea” size amount (0.5g) is

(1000 ppmF) recommended for fluorosis
susceptible children.
II. ORAL HYGIENE MEASURES

A. Tooth Brushing

B. Disclosing agents

C. Tooth paste

D. Other cleaning devices

E. Oral rinsing

F. Dental prophylaxis
 D.Other Cleaning Devices :
Sometimes it is advisable to use other devices than a tooth brush to
achieve thorough plaque removal.
Dental floss

The rubber tip

The tooth pick

The inter- dental brush

 i. Dental floss :

-Is a tool used to remove the microbial masses that are

located below the gum margins inter-proximally
-May be either waxed or un-waxed
-The un-waxed floss is recommended for: cleaning
purpose because when in use, strands open and trap
plaque and debris
-The thin nylon fibers of this floss serve as individual
knives or cutting edges to scrap the plaque from the
tooth
2. Other cleaning devices:

A- Dental floss:

B-The tooth pick:

C-The rubber tip:

D- The interdental brush:

• Technique of Flossing :
a. Cut off a length of about 6 inches (15 cm) and tie the ends
together to form a loop.
b. Hold between left thumb and right index finger (to clean
upper left quadrant and the fingers are reversed for the
right quadrant).
c. The floss is held between the fingers and gently worked
from the occlusal through the contact point down to the
gingival crevice, wrapped around half the circumference of
the tooth and scraped upwards for its entire length.
• Where it is impossible to introduce the floss through a
contact point (e.g. soldered contacts of bridge pontics or
splints) the floss is passed under the contact using a floss
holder
B-The tooth pick:
C-The rubber tip:
D The interdental brush:
 ii. The tooth pick :
- Used to remove bacterial masses from areas
inaccessible to the brush bristle.
- Effective in disturbing the plaque in
periodontal pockets, cleaning root surfaces,
cleaning buccal surfaces of third molars and
the lingual surfaces of lower molars.
- Medicated and plastic tooth picks are
available.
- Only recommended where there is sufficient
interdental space (not filled with gingival
tissues)
Technique:
 Inserted into the embrasure, pointed end first
 the stick at an angle of 45 degrees to the long axis of the tooth
 the sharp edge of the stick away from the gingiva
 The stick is rubbed about 12 times in each space with the tip
pointing coronally

Used in:
cases of wide embrasures while dental floss is preferred in cases of tight
interproximal contact.
 iii. The rubber tip:

Located on the handle of some tooth brushes

Helps in:
a. cleaning the interdental space
b. stimulating & massaging the gingival tissues
- Placed between the teeth pointing towards the
occlusal surface
- Held at 45 degree angle to the gum
- Pressure is maintained against the gum; and the tip
is vibrated
 iv. The inter-dental brush:

Is a single tufted brush

Used for:
- Cleaning the interdental spaces from the
lingual and labial aspects.
- Patient find no difficulty in its handling
Has the advantage of reaching posterior
areas easily.
II. ORAL HYGIENE MEASURES

A. Tooth Brushing

B. Disclosing agents

C. Tooth paste

D. Other cleaning devices

E. Oral rinsing

F. Dental prophylaxis
3- Oral rinsing:
4- Dental prophylaxis:
Decreases the formation of dental plaque
- by careful polishing
- Scaling
III- Topical protection of teeth:
This include all measures applied to increase the resistance of the intact
outer tooth surface.

Tooth

Composition Morphology Position

 THE HOST-TOOTH

• COMPOSITION-
SURFACE ENAMEL RESISTANT
MORE MINERAL
LESS CARBONATE & WATER
• MORPHOLOGY-
ENAMEL HYPOPLASIA
DEEP FISSURES
• POSITION-
ALIGNMENT
1- Fissure sealants:
Types:
Steps of application:
2- Preventive resin restorations:
Technique:
3- A traumatic restorative treatment (ART):
The two main principle of ART are:

Cavities suitable for ART should be:

The advantage of ART include:

1- Use of easily available and inexpensive procedure to conserve sound tooth surfaces.
2- Permit O.H.C workers to reach people who otherwise never would have received
any oral care.
 Laser light in preventive dentistry:
1- Increasing the resistance of dental hard tissues to
caries by reducing the rate of demineralization.

2- Sealing pits and fissures and homogenizes the enamel

surface by melting structural elements.

3- Laser application encourages fluoride uptake by

dental tissues.
4- Laser application to carious lesions vaporizes enamel
caries and adjacent sound enamel fuses and eliminate
small defects.
5- Application of laser prior to application of fissure
sealants improves its retention.
Prevention of dental caries with fluoride:
►What is fluoride? • Topical agents

►Sources of fluoride:

►Fluoride content of enamel : 2000-3000ppm • Fluoridated water

►Uptake of fluoride by teeth:
a) Before eruption b) After eruption

►Toxicity of fluoride: • Other ingested

sources
 Fluorosis

Fluorosis: is a hypoplasia or hypomineralisation of tooth enamel or dentine

produced by the chronic ingestion of excessive amounts of fluoride during
the period when teeth are developing.
The most critical ages are from 0 to 6 years. After 8 years, risk of fluorosis is
essentially past. During the critical ages F intake in excess of 0.1mg/kg body
weight/day can lead to fluorosis. This is roughly 1mg/day for a 1 to 2 year
old or 1.5 to 2 mg for a 5 year old.
Remember that all forms of F intake comprise the daily consumption. This
includes water intake (up to 1.5mg/day), foods (0.3 to 1.0mg) and especially
significant in young children, swallowed toothpaste.
 Criteria for Dean's Fluorosis Index
Criteria Score
The enamel represents the usual translucent semivitriform type of structure. The surface is Normal
.smooth, glossy, and usually of a pale creamy white color
The enamel discloses slight aberrations from the translucency of normal enamel, ranging from a Questionable
few white flecks to occasional white spots. This classification is utilized in those instances where
a definite diagnosis of the mildest form of fluorosis is not warranted and a classification of
."normal" is not justified
Small opaque, paper white areas scattered irregularly over the tooth but not involving as much as Very Mild
25% of the tooth surface. Frequently included in this classification are teeth showing no more than
about 1-2 mm of white opacity at the tip of the summit of the cusps of the bicuspids or second
.molars
The white opaque areas in the enamel of the teeth are more extensive but do not involve as much Mild
.as 50% of the tooth
All enamel surfaces of the teeth are affected, and the surfaces subject to attrition show wear. Moderate
.Brown stain is frequently a disfiguring feature
Includes teeth formerly classified as "moderately severe and severe." All enamel surfaces are Severe
affected and hypoplasia is so marked that the general form of the tooth may be affected. The major
diagnostic sign of this classification is discrete or confluent pitting. Brown stains are widespread
.and teeth often present a corroded-like appearance
Examples of Dental Fluorosis - Classified with the Dean Index

Mild Fluorosis Very Mild/Mild Fluorosis

Severe Fluorosis Moderate Fluorosis

Severe Fluorosis Severe Fluorosis

mild moderate

pitting severe
 FLUOROSIS

Maximum safe dose for

a 2 year old = 1 mg F / day
Maximum safe dose for
a 5 year old = 2 mg F /
day

F in excess of 0.1mg/ kg body weight

= fluorosis
POTENTIAL HARM
DMFT FLUOROSIS

10
9 severe
8
7 moderate
6
5 mild
4
slight
3
2
0.0 0.5 1.0 2.0 3.0 4.0

PPM F IN DRINKING WATER

F in excess of 0.1mg/ kg body weight

= fluorosis
POTENTIAL HARM
Probable toxic dose:
5 mg F / kg body weight
20 kg 6 year old, PTD = 100
mg F
10 kg 2 year old PTD =
50 mg F
Probable toxic dose (PTD)
F content of dental products or treatments may
exceed these values for young children. For
example, a gel tray containing 5 ml of APF contains
61.5mg F ,100ml of 0.2 or 0.4% F mouth rinse
contains 91 or 97mg F and a tube of fluoridated
toothpaste contains as much as 230mg F.
Symptoms:
1. Vomiting
2. Excessive salivation
3. Tearing and mucous discharge
4. Cold wet skin
5. Convulsion at higher dose
 POTENTIAL HARM

A serious systemic Counter Measures:

consequence is binding of
F to Ca which needed for 1. Emetics
heart function. 2. 1% calcium
chloride
F
3. Calcium gluconate F
F
4. Milk Ca
F Ca

Ca
Ca
Divalent cations like Ca cause
F
precipitation, of F and prevent F
F
Ca Ca F absorption in the intestine. Ca Ca
F F Ca F F Ca
Ca Ca
 Fluorosis in primary teeth
Dental fluorosis in primary teeth is considered to be relatively rare and/or less
severe in comparison to dental fluorosis in the permanent dentition .

This has been explained by a ‘placental barrier’, which was supposed to prevent the
transfer of fluoride from the mother's blood to the fetus.

Dental fluorosis is caused by excessive fluoride ingestion during the period of

enamel mineralization.

The calcification of all primary teeth starts during pregnancy and finishes before
the child is one year of age.

Opaque color of primary teeth obscure the enamel fluorosis.

Infant feeding habits should also be taken into consideration when considering the
prevention of dental fluorosis. Since breast milk is very low in fluoride , even after
a mother's intake of relatively high doses of fluoride , breastfeeding should be
encouraged.

Dental fluorosis is prevalent in the primary teeth of children living in areas

supplied with drinking water with fluoride concentrations higher than 1·0 mg L−1.
The primary teeth may act as biomarkers of fluoride exposure. The examination
of primary teeth may give an early warning of this condition, and thus, provide a
basis for intervention to prevent dental fluorosis in the permanent teeth.
 Mode of action of fluoride:

1- Ionic exchange.
2- Enzymatic inhibition (phosphates and anulase).
3- Bacterial inhibition in the dental plaque.
4- Fluoride has the ability to precipitate minerals from saturated solutions.
5- Fluoride lowers free surface energy.
6- Action on tooth size and morphology.
Methods of providing fluoride:

A) Systemic fluoride
1- Water fluoridation:
B) Topically applied fluoride
2- Fluoridation of school water supply:

3- Fluoride supplements

4- Fluoride incorporation in various foods:

Methods of providing fluoride:
B) Topically applied fluoride

1- Self administrated fluoride applications:

a) Fluoride tooth pastes
b) Mouth washes
c) Fluoride gel
d) Fluoride dental floss
 HOME F RINSES

Daily Rinse: Weekly Rinse

0.2% NaF, 0.091% free F, 910

ACT ppm F, 9.1 mg F / dose.

PREVI-
DENT
0.05% NaF, 0.023% free F,
230 ppm F, 2.3 mg F / dose

Indications:
1. High caries risk
2. Exposed roots
PHOS- 3. Prevention programs
FLOR

0.02% APF, 0.02% free F,

200 ppm F, 2 mg F / dose.
 HOME GELS

GEL-CAM – Indications:
0.4% SnF2, 1. Severe caries
0,097% free F, 2. Root caries
970 ppm F, 2-3mg 3. Prevention programs
F/ dose.

PREVIDENT –
1.1% NaF, 0.5% free
F, 5000 ppm, 10-25
mg F/ dose.

Radiation caries
2- Professionally applied fluoride:

a) Sodium fluoride:
b) Stannous fluoride:
c) Acidulated phosphate fluoride:
d) Prophylactic paste:
Professionally applied :-
Prophylactic paste
• In high risk caries patients
• Clean and supply fluoride in one step
• Contain zirconium silicate abrasive
 Fluoride varnishes
• Provide high uptake of fluoride into enamel
• Cost effective
 FLUORIDE VARNISH

Duraflor – 5% NaF, 26,000 ppm

F, 3-6 mg F per dose.

Fluor-Protector – 0.7%
silane F. Used as a cavity
varnish
 FLUORIDE VARNISH

Indications:

3. Exposed roots
and root caries

5. Erupting
teeth

1. All teeth in the

high risk patient

2. 6.
4. Carious anterior teeth in
White spots or other young children
Margins of
incipiencies restorations